50D2118806 CLIA NUMBER - TELECARE TUMWATER E AND T

Laboratory Demographics

CLIA Number: 50D2118806

Facility Name: TELECARE TUMWATER E AND T

Facility Address:
3285 FERGUSON ST SW
TUMWATER, WA
ZIP 98512
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Facility Phone Number: 360 943-1907

Facility Type: Other - RES TRMT/EVAL & TREATMENT

Certificate Type: Waiver

NPI Number: 1730532136

Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

CLIA Record

Field Name	Field Value
CLIA Number	50D2118806
LAB Type	Other - RES TRMT/EVAL & TREATMENT
Facility Name	TELECARE TUMWATER E AND T
Street	3285 FERGUSON ST SW
City	TUMWATER
State	WA
ZIP	98512
Phone	360 943-1907
CertificateType	4
CertificateEffectiveDate	9/14/2016
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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This page was last updated on: 4/23/2024